Direct Comparison of the Thickness of the Parietal Peritoneum Using Peritoneal Biopsy and Ultrasonography of the Abdominal Wall in Patients Treated with Peritoneal Dialysis

Author:

Abrahams Alferso C.1,Dendooven Amélie23,van der Veer Jan Willem1,Wientjes Rens4,Toorop Raechel J.5,Bleys Ronald L.A.W.6,Hendrickx Antoni P.A.7,van Leeuwen Maarten S.8,de Lussanet Quido G.9,Verhaar Marianne C.1,Stapper Gerard8,Nguyen Tri Q.2

Affiliation:

1. Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands

2. Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands

3. Department of Pathology, University Hospital of Antwerp, Edegem, Belgium

4. Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht, the Netherlands

5. Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands

6. Department of Anatomy, University Medical Center Utrecht, Utrecht, the Netherlands

7. National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands

8. Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands

9. Department of Radiology, IJsselmeer Hospital, Lelystad, the Netherlands

Abstract

Background Long-term treatment with peritoneal dialysis (PD) results in peritoneal fibrosis. Peritoneal biopsies have been used to determine the severity of fibrosis. Ultrasonography (US) of the abdominal wall has been used to measure peritoneal thickness non-invasively. However, direct comparison of both methods in the same patient has never been done. Furthermore, the validity of US to measure peritoneal thickness has not been investigated. Methods We performed 3 studies: 1) a human biopsy study to compare US measurement of peritoneal thickness with histological examination; 2) a human cadaver study to investigate the effect of removing the peritoneum on US results; and 3) a phantom study in which we used US to measure the thickness of membrane-like structures with a known thickness to investigate the influence of different US settings. Results The median thickness in biopsies of the peritoneum was 113 μm (interquartile range [IQR] 72 –129 μm), while this was 370 μm (IQR 324 – 458 μm) when measured by US ( p < 0.0001). The mean difference between the 2 measures was -257 μm (limits of agreement -4.6 and -511 μm). In the cadaver study, removal of the peritoneum did not have an effect on the presence or thickness of the hyperechoic line reported to represent the peritoneum. In the phantom study, results were highly dependent on frequency of the transducer, scan depth, and gain settings. Conclusions Ultrasonography results differ markedly from histological measurement using peritoneal biopsies. However, the hyperechoic line generated by US represents the interface between 2 neighboring tissues and not a separate morphological structure. Moreover, its thickness is greatly influenced by user-defined US settings.

Publisher

SAGE Publications

Subject

Nephrology,General Medicine

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